Provider Demographics
NPI:1932199387
Name:YOUNG, LAWRENCE H (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:789 HOWARD AVE
Mailing Address - Street 2:DANA BUILDING, 3RD FL
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1304
Mailing Address - Country:US
Mailing Address - Phone:203-785-4629
Mailing Address - Fax:203-785-3588
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:DANA BUILDING, 3RD FL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-785-4629
Practice Address - Fax:203-785-3588
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT023761207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001237619Medicaid
D85301Medicare UPIN
CT001237619Medicaid